Ringing in the ears, known as tinnitus, is most often caused by damage to tiny sensory cells inside your inner ear. About 10% of U.S. adults have experienced it in the past year, and globally the number rises to around 14% of adults. The damage can come from noise exposure, aging, medications, or a range of medical conditions, but the result is similar: your brain receives distorted signals and fills in the gaps with phantom sound.
How Your Brain Creates a Sound That Isn’t There
Your inner ear contains thousands of microscopic hair cells that convert sound vibrations into electrical signals for the brain. When some of these cells are damaged or lost, even in ways too subtle to show up on a standard hearing test, they send weaker or irregular signals along the auditory pathway. Your brain notices the drop in input and tries to compensate by turning up its own internal volume. Specifically, the parts of the brain responsible for processing the affected sound frequencies dial down their natural inhibition, essentially removing the brakes on neural activity in those zones.
Research published in the Proceedings of the National Academy of Sciences demonstrated this process directly. In the frequency range where hearing was damaged, inhibitory signaling in the auditory cortex dropped significantly while excitatory activity stayed the same. The imbalance produced spontaneous neural firing that the brain interpreted as sound. When researchers boosted inhibitory signaling with targeted compounds, the phantom sound perception stopped. This is why tinnitus so often matches the pitch range of a person’s hearing loss: the brain is compensating precisely where the damage occurred.
Noise Exposure and Age-Related Hearing Loss
Loud sound is the single most common trigger. Concerts, power tools, headphones at high volume, firearms, and industrial machinery can all destroy inner ear hair cells permanently. A single blast of extreme noise can cause immediate ringing, while years of moderate exposure gradually chips away at those cells until tinnitus becomes persistent.
Age compounds the problem. About one in three Americans between 65 and 74 has measurable hearing loss, and nearly half of those over 75 do. As high-frequency hearing fades with age, tinnitus often follows. Many people first notice a faint ringing in quiet rooms, which becomes more prominent over months or years. The combination of cumulative noise damage and natural aging means that tinnitus becomes increasingly common in middle age and beyond.
Medications That Can Trigger Ringing
Certain drugs are known to harm inner ear function. The risk depends on dose, duration, and whether you’re taking more than one of these medications at the same time. Harvard Health identifies several categories worth knowing about:
- High-dose aspirin and related pain relievers. At prescription-level doses (well above what you’d take for a headache), these can cause reversible tinnitus that usually fades when you stop.
- Certain antibiotics. Azithromycin and clarithromycin carry higher risk when prescribed at high doses for extended periods.
- Loop diuretics. These are commonly prescribed for heart failure and kidney disease. Furosemide is the most widely used example.
- Chemotherapy drugs. Cisplatin and carboplatin are particularly associated with hearing damage.
- Some biologics. Newer therapies including immunotherapy and gene therapy drugs can occasionally affect hearing.
Combining two or more of these medications raises the risk considerably. Taking cisplatin and furosemide together, for instance, may cause far greater hearing damage than either drug alone. If you notice new ringing after starting a medication, that’s worth bringing up with whoever prescribed it.
Jaw Problems and Muscle Tension
Your jaw joint sits remarkably close to the structures of your middle ear. The two share muscles, ligaments, and nerve pathways. When the temporomandibular joint (TMJ) is inflamed or misaligned, that irritation can alter how sound is perceived, producing or worsening tinnitus. A telling sign that your jaw may be involved: the ringing changes when you chew, clench your teeth, or yawn. Neck muscle tension and teeth grinding, especially during sleep, can contribute through the same shared anatomy. For people whose tinnitus is driven by jaw dysfunction, treating the TMJ issue often reduces or eliminates the ringing.
Blood Flow and Pulsatile Tinnitus
Some people hear a rhythmic whooshing or thumping that matches their heartbeat rather than a steady tone. This is pulsatile tinnitus, and it has a different set of causes. Instead of originating from damaged hair cells, it comes from turbulent blood flow near the ear. The Cleveland Clinic lists several conditions that can produce it:
- High blood pressure puts extra force on vessel walls near the ear.
- Atherosclerosis (hardened or narrowed arteries) creates uneven blood flow that generates more audible turbulence.
- Anemia increases overall blood flow volume, making the rushing sound louder.
- Hyperthyroidism speeds up the heart rate and boosts circulation.
- Abnormal blood vessel formations near the ear, including arteriovenous malformations, can create tangles that amplify the sound of blood flow.
- Increased pressure around the brain (idiopathic intracranial hypertension) presses on blood vessels and makes their pulsing audible.
Pulsatile tinnitus is more likely to have a treatable underlying cause than the steady-tone variety. Treating the blood pressure, thyroid condition, or vascular abnormality often resolves it.
Ménière’s Disease and Other Inner Ear Conditions
Tinnitus that arrives alongside episodes of intense spinning dizziness, fluctuating hearing loss, and a feeling of fullness or pressure in one ear may point to Ménière’s disease. This inner ear disorder causes fluid buildup that disrupts both balance and hearing. A key feature is that attacks of dizziness sometimes begin after a short period of worsening tinnitus or muffled hearing, making the ringing an early warning sign. Diagnosis typically requires at least two spontaneous vertigo episodes lasting 20 minutes to 12 hours, along with documented hearing loss in the affected ear. Other inner ear conditions, including benign growths on the hearing nerve, infections, and otosclerosis (abnormal bone growth in the middle ear), can also produce ringing as a primary symptom.
Stress, Caffeine, and Other Lifestyle Factors
Stress and anxiety don’t cause tinnitus on their own, but they reliably make existing tinnitus louder and harder to ignore. The brain’s threat-detection systems can latch onto the ringing and amplify attention to it, creating a feedback loop where stress worsens the perception and the perception increases stress.
Caffeine’s relationship with tinnitus is more nuanced than most people expect. A large South Korean study of over 13,000 participants found that daily coffee drinkers actually had 50 to 70 percent less hearing loss than people who rarely consumed coffee, and coffee consumption was linked to lower rates of tinnitus in adults under 65. A separate review of 142 studies found a similarly complex picture: two population-level studies reported that more caffeine correlated with less tinnitus. However, for people who already have tinnitus, moderate caffeine reduction (from roughly one to two cups daily) sometimes improved severity, while heavier drinkers were less likely to see improvement from cutting back. The old advice to eliminate caffeine entirely may not hold up for most people.
Alcohol, high salt intake, and poor sleep are commonly reported triggers, though individual sensitivity varies widely. Keeping a food and activity diary for a few weeks can help you identify your personal patterns.
When Ringing Requires Urgent Attention
Most tinnitus is bilateral, meaning it affects both ears roughly equally. Ringing in only one ear is considered a red flag. Unilateral tinnitus is a common presenting sign of both Ménière’s disease and vestibular schwannoma (a benign growth on the hearing nerve), and it warrants a hearing test followed by imaging if any asymmetric hearing loss is found.
Sudden hearing loss accompanied by new tinnitus in one ear is treated as a medical emergency. Rapid evaluation, ideally on the same day, gives the best chance of preserving hearing. If you wake up with significantly reduced hearing in one ear or lose hearing abruptly during the day, that’s a situation where getting seen quickly matters. Pulsatile tinnitus that you can hear beating in time with your pulse also deserves prompt evaluation, since it can signal vascular problems that are identifiable and treatable.